Provider Demographics
NPI:1952302127
Name:KATZ, ALAN M (PHD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:KATZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 OLD CAVE SPRING RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3419
Mailing Address - Country:US
Mailing Address - Phone:540-774-4211
Mailing Address - Fax:540-989-8793
Practice Address - Street 1:4330 OLD CAVE SPRING RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3419
Practice Address - Country:US
Practice Address - Phone:540-774-4211
Practice Address - Fax:540-989-8793
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001334103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007709226Medicaid
VA264464OtherPSYCHOLOGIST
VA7707614Medicaid
VA7707614Medicaid
VA264464OtherPSYCHOLOGIST
VA680001173Medicare ID - Type UnspecifiedPSYCHOLOGIST
VA680001033Medicare PIN